Tuesday, August 8, 2017

Helping Your Veterinarian Make the Diagnosis

If you think about it, being a cat
veterinarian is not very different from being a pediatrician. We can’t ask our
patients what’s wrong. We just have to figure it out.

Nowhere is the
role of a cat owner more important than at the veterinarian’s office, where a
good history can sometimes mean the difference between life and death.

Veterinarians are faced with a
variety of diagnostic challenges on a daily basis. The ability for a
veterinarian to obtain a detailed and complete history is our most important
diagnostic tool. When accurately interpreted, this information lays the
groundwork for a logical diagnostic and therapeutic plan, which may prevent
unnecessary

diagnostic
testing and needless discomfort to the patient and cost to the owner. After
briefly discussing the primary complaint, veterinarians try to obtain both
objective and subjective information when gathering the history. Examples of
objective data include the signalment, the environment, diet and medical
history.

The signalment consists of the cat’s
age, breed and gender, including the reproductive status, i.e. whether the cat
is neutered or spayed. This is basic and important information. Certain
illnesses tend to strike cats at certain age ranges. For example,
hyperthyroidism is a glandular condition that causes cats to lose weight
despite a ravenous appetite. It’s an old age disease, rarely striking cats
under the age of eight. A 13-year old cat with weight loss and excellent
appetite warrants a blood test to evaluate thyroid function. A four-year-old
cat with the same signs would be more likely to have something else, such as
inflammatory bowel disease or pancreatic insufficiency. Even if you’re not sure
of the exact age, an accurate approximation can be very useful for a
veterinarian. Certain breeds are predisposed to certain conditions and knowing the
breed can help veterinarians choose proper diagnostic tests. Persians are prone
to polycystic kidney disease; Ragdolls and Maine Coons are susceptible to
hypertrophic cardiomyopathy. Veterinarians must not be misled by clients who
tell their veterinarian that their cat is a Maine Coon, only to discover that
it’s a domestic longhair that, “looks just like the Maine Coon in the
magazine.” Gender provides important information as well. A female cat straining
to urinate is likely to have cystitis. A male cat straining to urinate could
have a urinary obstruction, something that can be life-threatening if not
treated promptly. Unlike age or breed, there’s very little guesswork when it
comes to determining gender. Just lift the tail and take a look!

Gathering environmental history is a
routine yet important part of a cat’s history. Free-roaming cats, or cats that
stay outdoors, are at a much higher risk of getting into fights with other
cats, which increases their risk of getting cat bite abscesses or acquiring
feline leukemia or FIV. Free-roaming, or recently escaped, cats may have had
access to toxins or have been subject to trauma, which is unlikely to occur
with an indoor pet. Sometimes a travel history is important, although this is
true more so with dogs than cats, because when cats travel with the owner to
another part of the country, they are not usually let outdoors where they are
at risk of running away or getting lost. Still, a travel history can be
important, especially if the patient has been exposed to diseases endemic to
certain regions but not prevalent in their normal environment.

A dietary history is more than
merely determining which type and brand of food you’re feeding your cat.
Granted, knowing the type of diet (dry, moist, table food), the brand name, any
types of snacks, the method of feeding (free-choice or individual meals) and
the amount is important; but, veterinarians also want to know about your cat’s
appetite and whether there has been any weight gain or loss. It’s helpful if
you watch your cat eat. Complete or partial anorexia is a common reason that
clients take their cat to the veterinarian. A client that notices that their
cat only chews on one side of its mouth, or has stopped eating dry food and now
will only eat canned food, is telling the veterinarian that oral pain or
discomfort may be the source of the problem and that a thorough oral exam may be
the only diagnostic test necessary to obtain the diagnosis.

Reviewing the patient’s prior
medical record can give valuable information to the veterinarian. If this is
your first visit to this particular veterinarian, it is very helpful if you
know your cat’s vaccination history as well as feline leukemia virus and feline
immunodeficiency virus status. Medical records detailing the diagnosis or
treatment of any prior or ongoing health problems are helpful, as the primary
complaint may be a consequence of a prior medical condition. Once the above
information is obtained, the veterinarian is ready to delve deeper into the
primary complaint. The history surrounding the primary complaint tends to be
more subjective and this information, obtained from observant, conscientious
owners, can be a tremendous asset. Veterinarians know that some owners aren’t
as observant as others. Our job is to encourage our clients to describe the
cat’s problem from its onset so that an orderly chronology is obtained. Some of
the things we’ll want to know are when the cat last seemed normal, whether the
onset of the clinical signs was sudden (acute) or if it developed slowly over
time (chronic) and whether or not the illness has responded to previous
treatment. For example, an itchy cat that was treated with steroids and did not
respond in the past is more likely to have food allergy (poorly responsive to
steroids) rather then flea-allergic dermatitis (responds rapidly to steroids).

Depending on what the primary
complaint is, a veterinarian may delve even deeper, to further help
characterize the problem and better formulate a diagnostic plan. As an example,
if a client reports that their cat has diarrhea, the veterinarian may then ask
whether there’s any blood or mucus in the stool, whether the cat has been
straining in the litter box or whether the cat has had any accidents in the
house. The more the client answers “yes,” the more likely that the diarrhea has
originated from the large intestine. This narrows down the list of possible
causes for diarrhea and helps the veterinarian formulate a diagnostic and
therapeutic plan.

Behavioral changes can be difficult for
veterinarians to interpret. I’ve had many clients bring in their cat because he
or she was acting differently, although upon further questioning, it became apparent
that the cat wasn’t actually ill despite the difference in behavior. Cats who
suddenly stop sleeping on the bed, even though it’s been their favorite
sleeping spot for years, or normally vocal cats that have lately become more quiet,
may indeed be acting differently, but these are more likely to be benign
behavioral changes. Lethargy, hyperactivity, aggression, growling and urinating
or defecating in inappropriate places, however, are behavioral changes that may
indicate an underlying medical problem. When in doubt as to whether any
apparently new behaviors are medically significant or not, it’s best to be on
the cautious side and report everything to your veterinarian. With the advent
of cell phones and the ability to quickly take a photo or a video, clients are
encouraged to photograph or videotape any unusual behaviors or symptoms, as a
video of a seizure, for example, or other odd behaviors can often serve as a
valuable supplement to the client’s verbal description.

Because our patients cannot talk,
veterinarians must rely on you, the client, to speak for them. The more
observant you are, the more information you can give us. This information can go
a long way toward obtaining the proper diagnosis, allowing us to tailor a
treatment plan to put your companion quickly on the road to recovery.

Dr. Arnold Plotnick (MS, DVM, ACVIM) blogs about professional and personal life experiences as an expert in the field of feline veterinary medicine.

Dr. Arnold Plotnick is a board-certified veterinary internist, feline expert, and the founder of Manhattan Cat Specialists. In addition to his medical work, he is an award-winning veterinary medicine writer.